<%--

  workForm component.

  

--%><%@include file="/apps/avventa/global.jsp"%><%
%>

<div class='<%= properties.get("jcr:class","double click to insert form") %>'>
<div class="workContent">
    <div class="textRequiredFields">
        <span> * Required Fields </span>
    </div>
    <div class="contentForm">
<form id="frmSubmitRFP" enctype="multipart/form-data" method="post" action="submit-RFP.php">
<div>
<div>
<div class="round-corners">
<div>
<strong>Name:</strong>
<span>*</span>
<br>
<input class="inputForm"   class="input class="inputForm" Form"  id="txtName" type="text"  maxlength="100" title="Name" name="txtName">
<br>
<strong>Job Title:</strong>
<span>*</span>
<br>
<input class="inputForm"   class="input class="inputForm" Form"  id="txtJobTitle" type="text"  maxlength="100" title="Job Title" name="txtJobTitle">
<br>
<strong>Organization Name:</strong>
<span>*</span>
<br>
<input class="inputForm"   class="input class="inputForm" Form"  id="txtOrganizationName" type="text"  maxlength="100" title="Organization Name" name="txtOrganizationName">
<br>
<strong>Department:</strong>
<br>
<input class="inputForm"   class="input class="inputForm" Form"  id="txtDepartment" type="text"  maxlength="100" title="Department" name="txtDepartment">
<br>
<strong>Address:</strong>
<br>
<input class="inputForm"   class="input class="inputForm" Form"  id="txtAddress" type="text"  maxlength="100" title="Address" name="txtAddress">
<br>
<strong>Address 2:</strong>
<br>
<input class="inputForm"   class="input class="inputForm" Form"  id="txtSuiteFloor" type="text"  maxlength="100" title="Suite/Floor" name="txtSuiteFloor">
<br>
<strong>City:</strong>
<br>
<input class="inputForm"   class="input class="inputForm" Form"  id="txtCity" type="text"  maxlength="100" title="City" name="txtCity">
<div style="width:auto;">
<div style="float:left;">
<strong>State:</strong>
<br>
<select id="txtState" style="background:#fff; border:solid 1px #999;" title="State" name="txtState">
<option value="Select One...">Select One...</option>
<option value="AL">Outside the U.S.A.</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select>
</div>
<div style="float:right; padding-left:0px;">
<strong>Zip Code:</strong>
<br>
<input class="inputForm"   class="input class="inputForm" Form"  id="txtZip" type="text" style="background:#fff; width:60px; border:solid 1px #999;" maxlength="25" title="Zip Code" name="txtZip">
</div>
</div>
<div style="clear:both;"></div>
<strong>Phone Number:</strong>
<span>*</span>
<br>
<input class="inputForm"   class="input class="inputForm" Form"  id="txtPhone" type="text" maxlength="100" title="Phone Number" name="txtPhone">
<br>
<strong>Email Address:</strong>
<span>*</span>
<br>
<input class="inputForm"   id="txtEmail" type="text"  maxlength="100" title="Email Address" name="txtEmail">
<br>
<strong>Preferred Method of Contact:</strong>
<span>*</span>
<br>
<input  id="txtPreferredContact" class="Medium" type="radio" value="Email" name="txtPreferredContact">
Email
<input  id="txtPreferredContact" class="Medium" type="radio" value="Phone"  name="txtPreferredContact">
Phone
<br>
<br>
<strong>Comments:</strong>
<br>
<textarea class="inputForm" id="txtComments" rows="3" title="Comments" name="txtComments"></textarea>
<br>
<input class="inputForm" id="buttonSumit"  class="SubmitButton" type="submit" value="">
</div>
</div>
</div>
</form> 
    </div>
</div>
</div>